PITTSBURGH, Pa., June 20, 2023 /PRNewswire/ — Advize Health is pleased to announce Rachel Jones has joined the company as President.

As President, Rachel joins the Executive Team and will focus on operations, product and services development, as well as the evolution of the company’s long-term strategic growth plans in the commercial, Medicare and Medicaid markets.

“I am excited to be joining the Advize Health team as it continues to evolve and expand its product and service offerings in the Program Integrity industry. Over the last ten years, Advize has consistently dedicated itself to combating healthcare fraud, waste and abuse, and I look forward to joining such a talented, passionate team of individuals that live by this mission every day.”

Rachel Jones, President, Advize Health

Rachel is a high-energy executive with a proven record of building and leading effective teams, successfully shepherding programs, and establishing best practices.  Her accomplishments include influencing enterprise bottom-line performance through expert alignment of processes with the corporate mission, engaging providers, and managing teams that span across Audit, Payment Integrity, and Special Investigations Unit. 

Most recently, Rachel served as Senior Director, Provider and Payment Solutions at Clover Health.At Clover, she drove organizational transformation, built successful and dynamic teams, and oversaw five departments: Payment Integrity, Special Investigation Unit (SIU), Provider Data Management, Provider Solutions, and Credentialing.  She was accountable for all five teams’ strategies, operational efficiencies, compliant processes, and staffing. 

In addition to her time at Clover Health, Rachel also spent over ten years at Highmark Blue Cross Blue Shield.  Much of her time was spent in the Financial Investigation and Provider Review department where during her tenure, she oversaw specific functions including vendor management, financial reporting, and Special Investigations. 

Throughout her career, Rachel has focused on establishing best of class Program Integrity strategies around maximizing pre-payment audits, establishing efficient internal audit processes, and building a diverse vendor portfolio that complemented the internal team’s audit work in order to maximize fraud, waste and abuse savings, while limiting overhead cost and provider abrasion.

In addition to her extensive healthcare experience, Rachel is a Certified Public Accountant as well as a Certified Fraud Examiner, having started her career in public accounting at Deloitte.

“I am thrilled to have Rachel join my Executive Team as our new President. This is an incredible opportunity for Advize to bring in another powerhouse leader who started her career in Big-4 and has grown tremendously in our industry. Rachel is a strategic and dynamic leader who is extraordinarily effective due to her strong healthcare industry knowledge and relationships that come from her vast years of experience. She has a proven track record of directing revenue growth and building high-performing teams.”

-Jeanmarie Loria, Chief Executive Officer, Advize Health

About Advize Health: At a time when the cost and quality of healthcare, as well as both technology and services, are at the forefront of payer conversation in the U.S., Advize Health is equipping payers to effectively address the rising costs incurred by fraud, waste, abuse, error and omissions. Through fully integrating technology and services provided by Advize, payers from small to large are able to achieve greater program integrity results while improving patient quality of care and supporting better health outcomes for those they serve. Advize Health is headquartered in Orlando, FL, and employs retired HHS-OIG experts, health insurance experts, doctors, nurses, coders and auditors nationally. For more information, please visit us at https://advizehealth.com/.

Media Contact: Nick Gould